A family is a group of individuals related by blood or marriage, living under the same shelter and share common kitchen. The group also shares a common property.

A group of persons united by the ties of marriage, blood, or adoption, constituting a single household and interacting with each other in their respective social positions, usually those of spouses, parents, children, and siblings.

There are several types of family:

Nuclear Family - A couple living with their unmarried children. 

Joint Family - Several married couples and their children live together. All men are related by blood. Women are wives, unmarried daughters and widows of the men. Property is held in common. All the income goes into family purse from which the expenditures are met.

Three Generation Family - Parents, Children and Grandchildren living together. The reason for sharing a kitchen and shelter is purely economical reasons. 

Extended Nuclear Family - A couple with their children and the siblings of the husband or wife, with their spouses and children. 

A ‘household’ is usually a group of persons who normally live together and take their meals from a common kitchen unless the exigencies of work prevent any of them from doing so. Persons in a household may be related or unrelated or a mix of both. However, if a group of unrelated persons live in a census house but do not take their meals from the common kitchen, then they are not constituent of a common household. Each such person should be treated as a separate household. The important link in finding out whether it is a household or not, is a common kitchen. There may be one member households, two member households or multi-member households.

A group of people who live in the same area (such as a city, town, or neighborhood) or a group of people who have the same interests, religion, race, etc.

D - Deaths and Births

E - Education

M - Marriage, Migration, Mother-tongue

O - Occupation

G - Gender/Sex

R - Religion, Ration card

A - Age, Address

P - Property - ownership/rental

H - Head o f Household

I - Income

C - Caste

• Required for record purpose (full name).

• To identify the individual.

• Addressing the patient by name helps in establishing the rapport in case of young individuals. Addressing elderly as aunt and uncle can be useful to build the rapport.

Head of the family is a  person who is recognized as head by the family members. The person bears the chief responsibility for managing the affairs of the household and takes decisions on behalf of the household. The head of household need not necessarily be the oldest male member or an earning member

• Age is important to note as in different age groups, different health problems occur.

  • In children - respiratory tract infections, diarrhoeal diseases are common.

  • In adolescents and youths - emotional problems, sexually transmitted diseases are common.

  • In middle age - non-communicable diseases are common.

  • In old age - diseases like osteoarthritis, dementia, hearing problems, and visual problems due to cataract are common.  

• Age also could indicate social problems and mental stress. e.g.  a female aged 30 years is still unmarried; an adult male, who should be employed is unemployed. 

• Age  also tells you if the consent can be given by the patient or needs to be taken from the guardian. 

• Counselling and advice to be given is dependent on age. In case of a child, instructions on how to take the medications, precautions to be followed, danger signals if any, when to follow up etc. is given to parents / guardians.  Parents / guardians are explained about the child’s condition. A little older children sometimes need to be explained about their condition. 

• Age is recorded in completed years. In the case of children below five years of age, it is recorded in days in the first month, month and days in the first year of life and subsequently as years and months till the age of five years.

• The pattern of diseases differs in men and women. 

• Lung cancer is more common in males.

• Obesity, osteoporosis is more common in females. 

• Religion and spirituality can impact decisions regarding diet, medicines based on animal products, modesty, and the preferred gender of their health providers. 

• Some religions have strict prayer times that may interfere with medical treatment. 

• Dietary habits, socio-cultural practices vary across religions and influence occurrence of diseases and health seeking behaviour. 

• Communities, that are pure vegetarians, Vitamin B12 deficiency is common but  Cysticercosis is rare.

• Adoption of Family Planning methods or abortion may be contrary to the religious belief of some communities.

• Skipping of medications during fasting can lead to complications or worsening of the disease.

• By knowing the religion and cultural practices of the patient, the health care provider can deliver health care needs that meet the cultural and religious needs.

Caste helps to identify socially disadvantaged groups who have higher probability of living under adverse conditions and poverty. It also indicates the vulnerability of the individual to social exclusion, discrimination and deprivation of basic needs.

• Unmarried are likely to have poor mental health and may feel depressed, lose their self esteem and confidence, indulge in high risk behaviour etc. Certain diseases like breast cancer are higher in unmarried women. 

• A widow could be depressed due to loneliness, or may face poverty due to lack of income source. Dependence on other family members, and uncaring attitude of children can further affect their mental and physical health. 

• Separated and divorced women could become dependent on other family members, be stressed due to children being separated from them, are vulnerable to exploitation by men. The non-acceptance and blaming attitude of the society towards women puts them at risk of mental health problems. 

• Marital status is recorded as never married/unmarried, married, separated/divorced and widow/widower.

• Literacy is defined as the ability to read and write in any language in a person aged 7 years and above.

• Educational status determines their attitude towards health and health seeking behaviour, which would greatly influence their health. 

• Low literacy levels contribute to poor knowledge and understanding about the disease. e.g. Illiterates are more likely to attribute diseases toward the curse of god, or witchcraft. 

• Illiterates may feel less confident of going to a hospital as they feel threatened and overwhelmed because of lack of knowledge. They are more likely to ignore the symptoms of disease. 

• While giving health education or counselling to individuals, their educational status determines to what extent the message has to be simplified.

• Illiterate people will be more likely to be engaged in labour or farming occupations. So they will be more susceptible to diseases like musculoskeletal, snake or scorpion bites etc. 

• Highly educated people will be likely to have office managerial work. They are prone to non-communicable diseases. 

• It is used for assessment of socioeconomic status by the Kuppuswamy classification. 

• In Kuppuswamy classification - education is classified as Illiterate, Primary school, Middle school, High school, Intermediate or Diploma, Graduate or Postgraduate, Professional/honours degree.

• An “occupational disease” is any disease contracted primarily as a result of an exposure to risk factors arising from work activity. “Work-related diseases” have multiple causes, where factors in the work environment may play a role, together with other risk factors, in the development of such diseases.

• Some diseases may be more common in specific occupations like contact dermatitis (exposure to chemicals in hair salons), lung cancer (asbestosis), COPD (exposure to dust, gases.), varicose veins (e.g. prolonged standing in bus conductors).

• Past occupations may influence the occurrence of present conditions. In coal miners, pneumoconiosis can present very late after exposure, maybe after their retirement.

• Occupation of the head of the family is  used for assessing socioeconomic status.  If an adult is unemployed, it could result in stress not only for the individual but also for the family.

• In Kuppuswamy classification, occupation is classified as unemployed, unskilled worker, semi-skilled worker, skilled worker,clerical/shop/farm, Semi-professional and Professional.

• An address in general helps to indicate the risk of occurrence of disease. e.g. if a person hails from a locality known to have a large number of cases of MDR-TB, then a clinician could have a high index of suspicion of MDR-TB in a TB suspect. 

• A patient diagnosed with Malaria with a recent travel from a chloroquine drug resistant area, may not respond to chloroquine, and would therefore need to be put on Artemisinin Combination therapy.

• A detailed address with landmarks, will help in defaulter retrieval action or home visits for counselling and motivation to continue treatment. 

• Address also gives an insight to the socio-economic and environmental factors that increase the individual’s susceptibility to diseases and health seeking behaviour.

A rental house means that the person is likely to move frequently from one rental house to another, which means not only instability and stress, but also the increased possibility of loss to follow up from the health-care system. 

A migrant is a person who moves from one place to another, especially in order to find work or better living conditions. According to the International Organisation for Migration, a migrant is defined as a person who moves away from his or her place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons. 

Migrants are those whose usual place of residence is different from the present place of enumeration. Usual Place of Residence (UPR) of a person is the place (village/town) where the person has been staying continuously for at least six months. 

Problems faced by migrants are due to 

• Lack of awareness about local health facilities

• Inability to cope with psychological stress

• Unhealthy sexual practices

• Frequent migration

• Food insecurity

• Climate changes, and other environmental hazards. 

• Poor working conditions

• Poor living conditions

• Lack of job security

• Meagre salary

• Inability to fulfil their own needs

• Exploitation by contractors

• Resort to drinking alcohol

• Household income generally is defined as the total gross income before taxes, received within a 12-month period by all members of a household It includes—but is not limited to—wage, salary, and self-employment earnings; pension, and other retirement income; investment income; welfare payments; and income from other sources.

• The conventional approach to measuring poverty is to specify a minimum expenditure (or income) required to purchase a basket of goods and services necessary to satisfy basic human needs. This expenditure is called the poverty line.

• A ration card is a document issued by the State Government that serves as identity proof and indicates an individual’s economic status. It is a document that helps an individual to avail of various government benefits provided to the holders of the card.

• In Maharashtra - three colour ration cards - yellow, saffron and white coloured cards.

  • Yellow Ration Cards - Families having annual income up to Rs.15,000/-(Urban Area)

  • Saffron Ration Cards - Families having annual income of Rs.15,001 to 1 lakh.

  • White Ration Cards - Families having annual income of Rs.1 Lakh or above,

• Mother tongue is the language that you first learn to speak when you are a child. Usually a person is more comfortable in expressing his/her feelings and emotions in their mother tongue. A person may know several languages and a language that the person is most comfortable speaking should be for communication, as far as possible. Communication with the individual in their mother tongue or the language that they speak helps in building rapport.

• In family case study, one should try to find out if there was a recent marriage or birth. This is important for educating the eligible couple on family planning methods as well as educating the mother on child care.

A family living in Mumbai has 8 family members. An elderly lady of 65 years and her 70 year old husband are living with her unmarried daughter and married two sons. The younger son is separated from his wife. The other son has two kids, a boy aged 8 years and a girl aged 4 years. The elderly lady’s daughter works in a bank earning about 60000 per month. The elder son works in a corporate office earning 1,00,000 per month. The younger son has his own accounting business earning around 1,50,000 per month. The daughter in law volunteers her time with an NGO to teach the children English. The old couple who were teachers by profession in a private college have a home in another city from which they receive a monthly rent of Rs. 50000. 

1. From the above case study, draw the family tree.

2. If you were asked to do the demographic assessment of the family, what information what additional questions you need to ask.

3. How many dependents are there in the family?

4. To calculate the literacy rate of a family, what would be the denominator?

5. What type of family is this? 

6. Do you need any additional information to classify the type of family.